Oral health of people with emotional disorders: A systematic review and meta-analysis.

OBJECTIVES: This study aims to determine the association between severe mental disorders and oral health among individuals over 18 years of age. METHODS: An electronic search was conducted in six electronic databases and gray literature. Qualitative and quantitative analyses were performed on studies that met the inclusion criteria. The methodology of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tool. A meta-analysis of proportions with a random effect was carried out. The certainty of evidence was evaluated using the GRADE tool. RESULTS: After searching the databases, 5,734 references were retrieved, and twenty articles were selected for synthesis. Considering the DMFT index between the groups with mental disorders and the control group, the values of the DMFT index were higher among individuals with schizophrenia [MD = 5.27; 95% CI = 4.13 - 6.42; I2 = 35%] and bipolar disorder [MD = 1.90; 95% CI = 0.87 - 2.93]. Values were lower among individuals with obsessive-compulsive disorder [MD = -0.85; 95% CI = -1.46-0.24]. The risk of bias was considered low for 16 studies, and four were classified with a moderate risk of bias. The certainty of evidence was very low. CONCLUSION: Patients with schizophrenia and bipolar disorder exhibit increased frequency in the number of decayed, missing, or filled teeth. There was no effect in relation to periodontal probing depth, plaque index, and TMD, but the evidence is still uncertain for this outcome. CLINICAL RELEVANCE: These findings underscore the need for a comprehensive health approach.

Effects of respiratory exercises in sleep bruxism and associated obstructive sleep apnea: a double-blind, placebo-controlled randomized clinical trial.

PURPOSE: The aim of this study is to assess the effects of respiratory exercises (inspiratory and expiratory) in individuals with sleep bruxism (SB) and associated obstructive sleep apnea (OSA). METHODS: This is a double-blind, placebo-controlled randomized clinical trial including individuals with SB and associated respiratory events in OSA. Respiratory physical therapy was performed using inspiratory (Threshold® IMT), expiratory (Threshold® PEP) muscle training, and compared with a placebo group. A total of 30 daily respiratory cycles (inspiration and expiration) were performed five times a week for 12 weeks. Individuals were reassessed at two times, at baseline (T1) and after 12 weeks of training (T2) by means of the Pittsburgh Sleep Quality Index and Polysomnography. RESULTS: Awakening was significantly different (p ≤ 0.05) between the inspiratory group and placebo 12 weeks after respiratory physical therapy. The number of contractions of the masseter muscle differed between the inspiratory, expiratory, and placebo groups (p ≤ 0.05). CONCLUSION: Respiratory physical therapy for OSA improved awaking levels in 80 and 67% of the number of masseter muscle contractions, when compared to placebo. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (No. RBR-9F6JKM).

Impact of the COVID-19 pandemic on the sleep quality of students: A meta-analysis and meta-regression.

OBJECTIVE: The present systematic review aims to assess the impact of the COVID19 pandemic on the sleep quality of students. METHODS: An electronic search was performed in the databases and in gray literature for articles published up to January 2022. The results included observational studies that assessed sleep quality through validated questionnaires, comparing moments pre and postCOVID19 pandemic. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. The Grading of Assessment, Development and Evaluation (GRADE) was used to assess the certainty of scientific evidence. Estimates of interest were calculated using random effects meta-analyses and possible confounding factors were meta-regressed. RESULTS: Eighteen studies were considered for qualitative synthesis and thirteen were considered for meta-analysis. Considering the comparison of means obtained by the Pittsburgh Sleep Quality Index, there was an increase in the scores obtained during the pandemic period [MD = -0.39; 95% CI = -0.72 - -0.07; I2 = 88.31%], thus evidencing a slight worsening in the sleep quality of these individuals. Risk of bias was considered low in nine studies, moderate in eight studies, and high in one study. The unemployment rate (%) in the country of origin of each included study partially explained the heterogeneity of analysis. GRADE analysis showed a very low certainty of scientific evidence. CONCLUSION: The COVID-19 pandemic may have a slight negative impact on the sleep quality of high school and college students, but the evidence is still uncertain. The socioeconomic reality must be considered when evaluating this outcome.

Impact of dentofacial deformity on the chance of being hired for a job.

Objective: This study aimed to determine the impact of dentofacial deformity on an individual's chances of being hired for a hypothetical job involving customer service. Materials and methods: Face photographs (frontal and lateral) of 15 patients with moderate to severe dentofacial deformity, taken before and after orthodontic-surgical correction, were selected and randomized between two different questionnaires. In addition, five patients without dentofacial deformity were used as controls in both questionnaires. These questionnaires were taken by adults responsible for hiring personnel to work in commerce and business activities, graduates or postgraduates in business administration, with experience in recruiting and hiring personnel. The evaluation took place using a Likert scale with values ranging from 0 to 10 (in which 0 corresponded to complete disagreement and 10 to complete agreement), considering the following variables in a first impression judgment: honesty, intelligence, productivity at work, and hiring chance. Data were tabulated and statistical analysis was performed using a linear regression model for the explanatory variables that showed statistical significance in the analysis of variance (ANOVA). Effect size through Cohen's d has been corrected for all comparisons performed. Results: All re-examined domains demonstrated statistical differences even when included in a multivariate model (p < 0.05), with lower mean values for those requiring pre-treatment (presenting deformity), although the effect size was small for all comparisons. Conclusion: Dentofacial deformity influenced the hiring chance, although not appearing to be a preponderant factor for hiring, acting as a tiebreaker among the candidates adopted.

Diagnosis of TMJ degenerative diseases by panoramic radiography: is it possible? A systematic review and meta-analysis.

OBJECTIVE: The objective of this work was to determine the diagnostic accuracy of panoramic radiography in detecting degenerative diseases of the temporomandibular joint. METHOD: The protocol was registered at the PROSPERO website. To consider the eligibility of studies to be included/excluded from this review, the acronym "PIRDS" was used and appropriate word combinations and truncations were adapted in the following electronic databases: PubMed/Medline, EMBASE, Latin American and Caribbean Literature on Health Sciences, Web of Science, Scopus, and Cochrane Library. RESULTS: A total of 2572 references, after the removal of duplicates, were retrieved from the eight electronic databases. After reading the titles and abstracts, a total of 26 articles were selected for full reading, of which ten were excluded, resulting in 16 articles included for qualitative synthesis. All in vivo studies were classified as having a low risk of bias. Regarding in vitro studies none of the included studies scored below 80% in the overall evaluation. CONCLUSIONS: Both in vitro and in vivo studies consistently report a low accuracy in detecting degenerative diseases of the temporomandibular joint using panoramic radiography. CLINICAL RELEVANCE: Cone-beam computed tomography offers a superior image quality without overlapping structures and a higher accuracy compared to panoramic radiography. However, panoramic radiography can still serve as an initial examination when combined with a clinical assessment. CBCT should be reserved for cases where there are evident clinical and/or radiographic alterations that recommend its use. This approach ensures a judicious and cost-effective use of CBCT resources.

The Prevalence of Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-analysis.

To determine the global prevalence of oropharyngeal dysphagia (OD) in adults. Six electronic databases (Embase, LILACS, LIVIVO, PubMed/Medline, Scopus, and Web of Science) were searched, in addition to gray literature (ASHA, Google Scholar, ProQuest Dissertation, and Theses). A random-effects model for meta-analysis of proportions was conducted, and heterogeneity was evaluated according to the moderator variable through subgroup analysis and meta-regression. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the certainty of the evidence was assessed using the GRADE tool. Thirty papers were included for qualitative and quantitative synthesis. The combined prevalence estimate was 60% [CI 95% = 50%-70%; I2 = 95%], accounting for different baseline conditions. However, the wide variation that exists between the different baseline conditions (underlying disease or risk factor) tended to overestimate this prevalence when considering the general population. Only one study evaluated healthy individuals, which showed a prevalence of 31% [CI95% = 27%-36%]. The risk of bias was considered low for all studies. None of the variables were considered predictors for the observed variance between the effect sizes of the included studies. For the prevalence of OD, the GRADE rating was considered very low. Despite the high prevalence observed, with over half of the individuals affected, the evidence regarding this outcome remains uncertain due to an overestimation of the generated estimates caused by the baseline condition of the sample.

Association between atypical swallowing and malocclusions: a systematic review.

OBJECTIVE: This systematic review aims to answer the following focus question: "Is there an association between atypical swallowing and malocclusions?". METHODS: Appropriate word combinations were chosen and tailored specifically for each of the following electronic databases: EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, Web of Science, and gray literature, without any restrictions, up to February 2021. According to the selection criteria, only cross-sectional studies were included. The following inclusion criteria were considered: a sample composed of children, adolescents, and adults; patients clinically diagnosed with atypical swallowing; patients with normal swallowing; and outcome of interest of atypical swallowing in patients with malocclusion. The data consisted of study characteristics, sample characteristics, results, and conclusion of each study. The risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, and the certainty of evidence was assessed using the GRADE tool. RESULTS: 4,750 articles were identified. After a two-step selection, four studies were included. A higher frequency of distal occlusion, extreme maxillary overhang, and open bite was related to swallowing disorders; most studies pointed to posterior crossbite as a malocclusion more associated with atypical swallowing. All studies had a moderate to high risk of bias, and the certainty of evidence was very low. CONCLUSION: The results indicate that atypical swallowing is associated with malocclusions and that posterior crossbite is the main malocclusion found, but only in the young population (3-11 years). REGISTRATION: PROSPERO (42020215203).

Worldwide prevalence and associated risk factors of obstructive sleep apnea: a meta-analysis and meta-regression.

PURPOSE: This study aimed to identify the prevalence of obstructive sleep apnea (OSA) and associated risk factors globally. METHODS: Six databases and registrations and three grey databases were explored for observational field research. Independently and impartially paired reviewers selected research, gathered data, and evaluated the methodological quality. Heterogeneity was investigated using subgroup analysis and meta-regression following the moderating variable in a meta-analysis of proportions with a random-effects model. The critical appraisal instrument developed by the Joanna Briggs Institute was used to evaluate the listed studies' methodology. The certainty of the evidence was evaluated using the GRADE tool. RESULTS: A total of 8236 articles were collected during the database search, resulting in 99 articles included for qualitative synthesis, and 98 articles were included for the meta-analysis. The estimated combined prevalence of OSA was 54% [CI 95% = 46-62%; I2 = 100%]. Mean age, percentage of moderate-severe cases, and the sample's body mass index (BMI) did not affect the heterogeneity that was already present when meta-regressed (p > 0.05). Ninety-one studies were deemed to have a low risk of bias, while eight were deemed to have a moderate risk. For OSA prevalence outcomes, the GRADE criteria were considered very low. CONCLUSION: Approximately half of the people worldwide have OSA. High BMI, increasing age, and male gender are described as risk factors in the literature, but these covariates do not affect pre-existing heterogeneity.

Periodontal parameters in orthodontically tractioned teeth: A systematic review and meta-analysis.

Objective: This systematic review aimed to evaluate periodontal parameters in orthodontically tractioned teeth compared with the respective non-tractioned contralateral teeth. Methods: Search strategies were developed for six electronic databases and gray literature. Random-effects meta-analyses were performed for the outcomes of interest. Furthermore, the certainty of the evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool. Results: Overall, 2,082 articles were identified, of which 24 were selected for the qualitative synthesis. A significant difference was observed between the impacted and contralateral teeth (mean difference [MD] = 0.25; 95% confidence interval [CI] = 0.10-0.40; I2 = 0%) when the gingival index was evaluated. Additionally, impacted teeth showed a greater probing depth, with a significant mean difference between the groups (MD = 0.14; 95% CI = 0.07-0.20; I2 = 6%). Most studies had a low risk of bias; however, the certainty of the evidence was very low owing to the design of existing studies. Conclusions: The evidence in the literature indicated that tractioned teeth might show worsening of periodontal parameters related to the gingival index and probing depth; however, the evidence remains uncertain about this outcome. Furthermore, probing depth should be considered regarding its clinical significance because of the small effect size observed.

Effect of the patient-centered care model on health professional satisfaction: a systematic review.

OBJECTIVE: To analyze the effect of the Patient-Centered Care model on the satisfaction of health professionals, nurses, speech therapists or dentists, who care for hospitalized adults. METHOD: Systematic Review conducted from October/2020 to March/2021 at PubMed/Medline, CINAHL, EMBASE, SCOPUS, Web of Science and LILACS databases. Observational and interventional studies were included, relating the effect of Patient-Centered Care on the satisfaction of professionals. The Cochrane Collaboration Tool and Meta-Analysis of Statistics Assessment and Review Instrument tools assessed the methodological quality of the studies. RESULTS: The effect of patient-centered care on job satisfaction was not identified in speech therapists or dentists. Nine selected articles relate it to nurses. Predictors of satisfaction pointed to factors related to interpersonal relationships, patient care and work organization. CONCLUSION: The Patient-Centered Care model can be a facilitating strategy for nurses' job satisfaction. However, the current scientific literature still needs further studies to strengthen existing evidence.

Temporomandibular disorder in construction workers associated with ANKK1 and DRD2 genes.

The study aimed to explore the influence of genetic polymorphisms in ANKK1 and DRD2 on the signs and symptoms of temporomandibular disorder (TMD) in construction workers. This cross-sectional study included only male subjects. All construction workers were healthy and over 18 years age. Illiterate workers and functionally illiterate workers were excluded. The diagnosis of TMD was established according to the Research Diagnostic Criteria for TMD (RDC/TMD). Genomic DNA was used to evaluate the genetic polymorphisms ANKK1 (rs1800497) and DRD2 (rs6275; rs6276) using Real-Time PCR. Chi-square or Fisher exact tests were used to evaluate genotypes and allele distribution among the studied phenotypes. The established alpha of this study was 5%. The sample included a total of 115 patients. The age of the patients ranged from 19 to 70 years (mean age 38.2; standard deviation 11.7). Chronic pain (87.7%), disc displacement (38.2%), and joint inflammation (26.9%) were the most frequently observed signs and symptoms. The genetic polymorphism rs6276 in DRD2 was associated with chronic pain (p=0.033). In conclusion, our study suggests that genetic polymorphisms in DRD2 and ANKK1 may influence TMD signs and symptoms in a group of male construction workers.

Temporomandibular disorder in construction workers associated with ANKK1 and DRD2 genes

Abstract The study aimed to explore the influence of genetic polymorphisms in ANKK1 and DRD2 on the signs and symptoms of temporomandibular disorder (TMD) in construction workers. This cross-sectional study included only male subjects. All construction workers were healthy and over 18 years age. Illiterate workers and functionally illiterate workers were excluded. The diagnosis of TMD was established according to the Research Diagnostic Criteria for TMD (RDC/TMD). Genomic DNA was used to evaluate the genetic polymorphisms ANKK1 (rs1800497) and DRD2 (rs6275; rs6276) using Real-Time PCR. Chi-square or Fisher exact tests were used to evaluate genotypes and allele distribution among the studied phenotypes. The established alpha of this study was 5%. The sample included a total of 115 patients. The age of the patients ranged from 19 to 70 years (mean age 38.2; standard deviation 11.7). Chronic pain (87.7%), disc displacement (38.2%), and joint inflammation (26.9%) were the most frequently observed signs and symptoms. The genetic polymorphism rs6276 in DRD2 was associated with chronic pain (p=0.033). In conclusion, our study suggests that genetic polymorphisms in DRD2 and ANKK1 may influence TMD signs and symptoms in a group of male construction workers.

Resumo O objetivo do estudo foi explorar a influência de polimorfismos genéticos em ANKK1 e DRD2 sobre os sinais e sintomas da disfunção temporomandibular (DTM) em trabalhadores da construção civil. Este estudo transversal incluiu apenas indivíduos do sexo masculino. Todos os trabalhadores da construção civil eram saudáveis ​​e maiores de 18 anos. Foram excluídos os trabalhadores analfabetos e analfabetos funcionais. O diagnóstico de DTM foi estabelecido de acordo com o Research Diagnostic Criteria para DTM (RDC/TMD). O DNA genômico foi usado para avaliar os polimorfismos genéticos ANKK1 (rs1800497) e DRD2 (rs6275; rs6276) usando PCR em tempo real. Testes qui-quadrado ou exato de Fisher foram utilizados para avaliar genótipos e distribuição de alelos entre os fenótipos estudados. O alfa estabelecido deste estudo foi de 5%. A amostra incluiu um total de 115 pacientes. A idade dos pacientes variou de 19 a 70 anos (média de idade 38,2; desvio padrão 11,7). Dor crônica (87,7%), deslocamento de disco (38,2%) e inflamação articular (26,9%) foram os sinais e sintomas mais observados. O polimorfismo genético rs6276 em DRD2 foi associado a dor crônica (p=0,033). Em conclusão, nosso estudo sugere que polimorfismos genéticos em DRD2 e ANKK1 podem influenciar sinais e sintomas de DTM em um grupo de trabalhadores da construção civil do sexo masculino.

Comparison of orthodontic root resorption of root-filled and vital teeth: A meta-analysis.

BACKGROUND: In this systematic review, the authors aimed to answer the following question: Do vital teeth differ in the level of external root resorption induced by means of orthodontic treatment compared with root-filled teeth? TYPES OF STUDIES REVIEWED: The search strategy was performed in 6 electronic databases and in gray literature for articles published until July 29, 2021. Two reviewers independently assessed potentially eligible studies according to the following criteria: studies that evaluated patients undergoing fixed orthodontic therapy and compared the mean difference in millimeters of orthodontically induced external root resorption in endodontically treated teeth with the vital contralateral tooth. Only randomized, quasi-randomized, nonrandomized, cohort, case-control, or cross-sectional studies were considered eligible. There were no restrictions on language or publication time. Two reviewers also independently extracted data on the characteristics of the included studies, methods, and results, and performed risk-of-bias analysis using the Meta-Analysis of Statistics Assessment and Review instrument. Estimates of interest were calculated using random-effects meta-analyses. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: Eleven studies were included in the quantitative synthesis. Endodontically treated teeth had a lower level of root resorption (mean difference, 0.45 mm; 95% CI, -0.69 to -0.21 mm). However, the level of certainty of the evidence was considered very low owing to confounding factors. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Endodontically treated teeth may have a lower level of orthodontically induced root resorption than vital teeth, but the evidence is still uncertain about this outcome. Furthermore, owing to the small effect size, this difference might not be clinically significant (up to 1 mm).

Psychosocial changes in patients submitted to orthodontic surgery treatment: a systematic review and meta-analysis.

OBJECTIVE: This systematic review aims to answer the following question: What is the psychological impact of orthognathic surgery on patients with dentofacial deformities undergoing orthodontic-surgical treatment? MATERIAL AND METHODS: The search was adapted for each of the following databases: American and Caribbean Center on Health Sciences (LILACS), Cochrane Library, Embase, Psychinfo, PubMed/Medline, Scopus and Web of Science, and gray literature using Google Scholar, OpenGrey, and ProQuest. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. This study performed estimates of interest, random-effects meta-analyses, and calculated heterogeneity using Higgins inconsistency index (I2). RESULTS: A total of 6751 references were found in all searches. After applying the eligibility criteria after full-text reading, 37 studies comprised the final qualitative synthesis. Thirteen studies were included in quantitative synthesis, and it was possible to meta-analyze data from the following questionnaires: GHQ-28, MMPI, RSES, and SCL-90-R. There was an improvement in psychological aspects related to depression, hysteria, self-esteem, anxiety, obsessive-compulsiveness, interpersonal sensitivity, paranoid ideas, and psychoticism (p < 0.05). CONCLUSIONS: Correction of dentofacial deformity through orthodontic-surgical treatment is associated with improvements observed in several psychological domains, especially in relation to depressive states. CLINICAL RELEVANCE: This result highlights the importance of surgeons and orthodontists in promoting adequate control of patients' expectations and treatment goals taking into account the individual's psychological aspects.

Front lines of the COVID-19 pandemic: what is the effectiveness of using personal protective equipment in health service environments?-a systematic review.

PURPOSE: This systematic review aimed to evaluate the effectiveness of the use of personal protective equipment (PPE) in closed environments, similar to waiting or exam rooms of healthcare facilities, in the face of exposure to a bioaerosol. METHODS: Combinations of words were selected for six electronic databases and for the gray literature. To consider the eligibility of the studies to be included/excluded, the acronym "PECOS" was used: humans and/or experimental models that simulate aerosol (Population); aerosol exposure and the use of masks/respirators (exposition/intervention); controlled or not controlled (comparison); effectiveness of PPE and the receiver exposure (outcomes); and randomized clinical studies or not, observational or laboratory simulation studies (Studies design). RESULTS: A total of 4820 references were retrieved by the search strategy. Thirty-five articles were selected for complete reading, of which 13 articles were included for qualitative synthesis. A surgical mask or N95 respirator reduced the risk of transmission, even over short distances. The use of masks, even those with less filtering power, when used by all individuals in the same environment is more effective in reducing risk than the use of respirators with high filtering power for only some of the individuals present. CONCLUSION: The use of mask in closed environments is effective in reducing the risk of transmission and contagion of a contaminated bioaerosol, with greater effectiveness when these devices are used by the source and receiver, regardless of the equipment's filtering power. (PROSPERO 2020 CRD 42020183759).

Risk factors associated with the stability of mini-implants and mini-plates: systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review is to assess the risk factors associated with the stability of mini-implants and mini-plates in patients undergoing orthodontic treatment using temporary anchorage devices. MATERIAL AND METHODS: Search strategies were developed for each electronic database (PubMed/Medline, LILACS, Scopus, Web of Science, Embase, and Cochrane Library) and gray literature (Google Scholar, Proquest, and Open Grey). The risk of bias was assessed using the Cochrane Collaboration tool for assessing the risk of bias and Meta-Analysis of Statistics Assessment and Review Instrument. The certainty of the evidence was assessed using the GRADE tool. Meta-analyses and meta-regressions of random effects were performed for the outcomes of interest. RESULTS: A total of 1517 articles were found, of which seven were selected for quantitative synthesis. When comparing the risk of failure between mini-implants and mini-plates, the risk values approached the threshold of statistical significance (p = 0.07) (RR = 1.83; 95% CI = 0.96-3.50; I2 = 69%), showing significance after sensitivity analysis (p < 0.05) and a greater risk for mini-implants. Mandible installation presented a higher risk of failure (RR = 1.85; 95% CI = 1.17-2.91). CONCLUSIONS: The evidence found indicates that failure in the stability is related to the type of device and that there is a greater risk by using isolated mini-implants, especially when positioned in the mandible. CLINICAL RELEVANCE: These findings help the orthodontist and/or the surgeon to stipulate risks, learn about the predictability of techniques, and communicate with the patient in an easier way.

Effects of respiratory training on obstructive sleep apnea: systematic review and meta-analysis.

PURPOSE: This systematic review sought to answer the following focused question: "What are the effects of respiratory training devices on obstructive sleep apnea (OSA) outcomes in adults?" METHODS : The acronym "PICOS" was used to determine eligibility criteria, which consists of (P population) = adults with mild to moderate OSA, (I intervention) = spirometry devices or breathing exercises, (C comparison) = compared to no breathing exercises in adults (> 18 years) with mild to moderate OSA, (O outcomes) = improved sleep quality (sleep quality indexes) and improved apnea-hypopnea indexes (AHI), (S study types) = randomized, pseudo-randomized, and non-randomized clinical trials. The search was performed in the following databases: PubMed/Medline, LILACS, Scopus, Web of Science, Scopus, and Cochrane Library, in addition to gray literature through Google Scholar, Proquest, and Open Grey. The risk of bias was assessed using the Cochrane Collaboration tool. The certainty of the evidence was assessed using the GRADE tool. Meta-analyses of random effects were performed for the outcomes of interest. RESULTS: A total of 1171 references were found. Applying the eligibility criteria, six studies were included in qualitative synthesis. Expiratory exercises showed a decrease in the apnea-hypopnea index (AHI) when compared to baseline (MD = - 8.4; 95% CI = - 12.4 to - 4.4; I2 = 19%). There was a decrease in values compared to baseline (MD = - 4.4; 95% CI = - 8.2 to - 0.6; I2 = 0%) for the Epworth Sleepiness Scale (ESS), when considering the inspiratory exercises. Both groups of breathing exercises showed a significant decrease in the mean index assessed by the Pittsburgh Sleep Quality Index (PSQI). CONCLUSION: Results of this meta-analysis suggests that breathing exercises lead to a measurable improvement in AHI for patients with mild to moderate OSA, as well as an improvement in sleep quality and daytime sleepiness. SYSTEMATIC REVIEW REGISTRATION: CRD42020148513 (PROSPERO).

Effect and longevity of botulinum toxin in the treatment of gummy smile: a meta-analysis and meta-regression.

OBJECTIVE: The aim of this systematic review is to synthesize the evidence on the effectiveness and longevity of the botulinum toxin in the treatment of individuals with excessive gingival exposure. METHODS: The search was adapted to six electronic databases and gray literature. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool for Non-Randomized and Randomized Studies of Interventions. Meta-analyses and meta-regression were performed using random effects models. RESULTS: A total of 5247 articles were collected during the final search in the database, resulting in 17 articles included. There was a mean decrease of 3.42 mm [95% CI = -4.50 to -2.34; I2 = 97%] in the level of gingival exposure 2 weeks after the application of botulinum toxin. The application time explained 29.58% of the observed variance (p < 0.001), with a tendency for the effect size to decrease from the second week of application onwards, with values returning close to baseline levels in 24 weeks. CONCLUSION: Botulinum toxin is an alternative technique considered effective for reducing gummy smile, especially for gummy smiles up to 4 mm, with a longevity of at least 12 weeks, returning close to initial values within 24 weeks after application. CLINICAL RELEVANCE: The knowledge about the longevity and effectiveness of botulinum toxin in the treatment of gummy smile allows for a more adequate clinical planning for these cases, as well as for clinical decisions, as for prognostic factors.

Deglutition assessment instruments used in critical patients submitted to orotracheal extubation: a scoping review

ABSTRACT Purpose: to map, through a literature survey, which instruments are used to assess swallowing in patients after orotracheal extubation. Methods: available evidence was mapped through six electronic databases and gray literature. There were no restrictions regarding gender, ethnicity of the individuals, language of the studies, time of publication, and diagnosis. Results: the most mentioned protocol in the studies was the Dysphagia Risk Evaluation Protocol and the most cited objective assessment exam was the flexible endoscopic evaluation of swallowing. Conclusion: there is a need for a specific protocol to evaluate this profile of patients, in addition to comparative studies of subjective clinical evaluation and instrumental imaging.

Association between atypical swallowing and malocclusions: a systematic review

ABSTRACT Objective: This systematic review aims to answer the following focus question: "Is there an association between atypical swallowing and malocclusions?". Methods: Appropriate word combinations were chosen and tailored specifically for each of the following electronic databases: EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, Web of Science, and gray literature, without any restrictions, up to February 2021. According to the selection criteria, only cross-sectional studies were included. The following inclusion criteria were considered: a sample composed of children, adolescents, and adults; patients clinically diagnosed with atypical swallowing; patients with normal swallowing; and outcome of interest of atypical swallowing in patients with malocclusion. The data consisted of study characteristics, sample characteristics, results, and conclusion of each study. The risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, and the certainty of evidence was assessed using the GRADE tool. Results: 4,750 articles were identified. After a two-step selection, four studies were included. A higher frequency of distal occlusion, extreme maxillary overhang, and open bite was related to swallowing disorders; most studies pointed to posterior crossbite as a malocclusion more associated with atypical swallowing. All studies had a moderate to high risk of bias, and the certainty of evidence was very low. Conclusion: The results indicate that atypical swallowing is associated with malocclusions and that posterior crossbite is the main malocclusion found, but only in the young population (3-11 years). Registration: PROSPERO (42020215203).

RESUMO Objetivo: A presente revisão sistemática tem como objetivo responder à seguinte questão focal: "Existe associação entre deglutição atípica e más oclusões?". Métodos: Combinações de palavras e truncamentos apropriados foram adaptados para as bases de dados eletrônicas: EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), LIVIVO, PubMed/Medline, Scopus e Web of Science e a literatura cinzenta, sem qualquer restrição, até fevereiro de 2021. Os critérios de inclusão foram: estudos transversais; amostra composta por crianças, adolescentes e adultos; pacientes com diagnóstico clínico de deglutição atípica; pacientes com deglutição normal, e o desfecho de interesse foi deglutição atípica em pacientes com má oclusão. Os dados extraídos de cada estudo foram características do estudo, da amostra e a conclusão. O risco de viés foi avaliado usando a Lista de verificação de avaliação crítica da JBI para estudos transversais analíticos, e a certeza das evidências foi avaliada usando a ferramenta GRADE. Resultados: Foram identificados 4.750 artigos. Após uma seleção em duas fases, quatro estudos foram incluídos. Maior frequência de disto-oclusão, protuberância maxilar extrema e mordida aberta foram relacionadas a distúrbios da deglutição, com a maioria dos estudos apontando para mordida cruzada posterior como a má oclusão mais associada à deglutição atípica. Todos os estudos tiveram um risco de viés moderado a alto, e a certeza das evidências foi considerada muito baixa. Conclusão: Os resultados indicam que a deglutição atípica está associada à mordida cruzada posterior apenas na população jovem de 3 a 11 anos.